Treatment of glomerular diseases: ANCA-negative RPGN

Classification of rapidly progressive glomerulonephritis (RPGN) has evolved over the last decade into a variety of categories, some are which are more amenable to treatment than others. The advent of testing for antineutrophilic cytoplasmic antibody (ANCA) has further defined RPGN and aided in the diagnosis and treatment of these diseases. Although RPGN has traditionally carried a poor prognosis, this has been markedly improved by early diagnosis and intervention with aggressive therapy. The current chapter provides an oversight of ANCA-negative RPGN, and delineates an approach to diagnosis and therapy of various subtypes of this entity. Although current therapeutic options still encompass broad-spectrum immunosuppressive modalities, the future holds great hope for specific directed interventions at discrete points in the pathogenic progress. This offers the possibility of abrogation of the immune response leading to RPGN with less toxic general side effects then with treatments currently used. The next millennium will be marked by improved prognosis for ANCA-negative glomerulonephritis compared with that observed with this devastating disease in past decades.